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Trends and indications for cesarean section in the ORIGINS birth cohort
Kristjana Einarsdottir1,2,3, Lisa Gibson1,4, Sarah Whalan1
1ORIGINS, The Kids Research Institute Australia, Nedlands, Western Australia, Australia.
Objective:
Cesarean section (CS) rates have increased substantially in Australia, with particularly high use observed in private maternity care and for pre-labor CS. The aim of the present study was to describe the CS rates and the clinical indications for pre-labor CS in the ORIGINS birth cohort.
Methods:
This study analyzed data from the ORIGINS birth cohort, a large birth cohort in Western Australia, including 9473 births occurring at Joondalup Health Campus between 2016 and 2024. Rates of CS and pre-labor CS were compared across study periods (2016-2020 and 2021-2024) and by facility type (public vs. private). Indications for pre-labor CS were described and compared across study periods and facility type. Poisson regression was used to assess the change in CS rates across study periods, adjusted for maternal demographic and pregnancy characteristics.
Results:
Overall CS rates were 50.4% for the study cohort. They increased from 48.2% in 2016-2020 to 52.3% in 2021-2024 (adjusted risk ratio [aRR] 1.10, 95% confidence interval [CI] 1.06-1.14) and were 46.2% in public facilities and 62.0% in private facilities. Pre-labor CS rates increased from 31.4% to 36.2% (aRR 1.15, 95% CI 1.10-1.23) and were 28.5% in public facilities and 49.1% in private facilities. Previous cesarean section was the most common indication for pre-labor CS and increased in prevalence across study periods (from 50% to 53.2%). Pre-labor CS performed at maternal request also increased (from 10.8% to 15.3%) and was more common in private hospital facilities (public, 10.8%; private, 17.7%).
Conclusions:
CS rates in the ORIGINS birth cohort appeared to be higher than in the broader Western Australian birthing population. Pre-labor CS contributed substantially to rising CS rates in this cohort and was particularly common in private settings. Similarly, pre-labor CS performed at maternal request increased over time and was more common in private settings. Identifying the factors driving CS use is increasingly important.
